PROJECT SUMMARY/ABSTRACT Changes in the healthcare delivery system have been brought about nationally by the Affordable Care Act and the Mental Health Parity and Addiction Equity Act and locally by a number of Washington State initiatives. As part of these changes substance use disorder (SUD) treatment is being expanded beyond specialty care and integrated into primary care and acute care medical settings where SUD prevalence rates are high. These initiatives have led to an increased focus on SUD screening, brief intervention, and referral to treatment (SBIRT) in these settings. These integrative initiatives are based on collaborative care and chronic disease management approaches. There is an increased need for future research to develop and test the effectiveness of SUD interventions implemented in healthcare settings and linked to specialty SUD treatment programs. This viewpoint also reflects the future direction of the NIDA National Drug Abuse Treatment Clinical Trials Network (CTN) as it expands its research focus beyond community-based specialty treatment programs (CTPs). In order to contribute to the CTN's expanded objectives and research priorities, the Pacific Northwest (PNW) Node proposes the following Specific Aims: (1) Increase the capacity of the PNW Node research team by adding investigators with demonstrated practical and research expertise in developing and coordinating primary care practice-based research networks and collaborative care models, integrating behavioral health and SUD treatment components into primary and acute care settings, and harmonizing and using electronic medical record systems across multiple health care systems; (2) Expand the scope, population, diversity, and focus of research and clinical practice settings affiliated with the PNW Node by adding to our current CTPs a number of large state-wide and regional practice-based primary care clinical and research networks and programs involved in integrated behavioral health collaborative care; (3) Design and conduct pragmatic, comparative effectiveness, registry, and other types of innovative studies, informed bidirectionally by SUD researchers and clinicians and primary and acute care providers, that evaluate SBIRT, integrated behavioral and pharmacological treatments, and components of collaborative care for tobacco, alcohol, illicit drugs, and misused prescription opioid medications; and (4) Through the CTN National Dissemination Library, the Northwest and the Central Rockies Addiction Technology Transfer Centers, and resources within the Alcohol and Drug Abuse Institute provide training to health care and SUD providers about SUDs, collaborative care and chronic disease management models, the integration process, and methods of effective linkage between primary care and specialty SUD CTPs. Such training also provides opportunities for dissemination research.